1 / 36

DOT National Standard EMT-Intermediate/85 Refresher

Welcome!. DOT National Standard EMT-Intermediate/85 Refresher. MEDICAL EMERGENCIES. Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease. Diabetes. Perspective Pathophysiology

Download Presentation

DOT National Standard EMT-Intermediate/85 Refresher

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Welcome! DOT National Standard EMT-Intermediate/85 Refresher

  2. MEDICAL EMERGENCIES • Allergic reaction • Possible overdose • Near-drowning • ALOC • Diabetes • Seizures • Heat & cold emergencies • Behavioral emergencies • Suspected communicable disease

  3. Diabetes Perspective Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment MEDICAL EMERGENCIES

  4. definition • Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both

  5. description • Hyperglycemia further results in acute & chronic complications of the disease, leading to significant morbidity and mortality

  6. description • American Diabetes Association (one of the following must be met): • Symptoms of diabetes & a causal plasma glucose >200mg/dL • Fasting plasma glucose >126mg/dL • Two-hour plasma glucose >200mg/dL during a 75g, 2-hr oral glucose tolerance test

  7. description • Prediabetes • Impaired fasting glucose • 100-125mg/dL • Impaired glucose tolerance • 140-199mg/dL

  8. epidemiology • 7% of the US population has diabetes • 5-10% Type 1 • 90-95% Type 2

  9. epidemiology • T2DM prevalence among youth is rising • Old figure = 1 to 2% of diabetic children had T2DM • New figure = 8 to 45% of diabetic children have T2DM

  10. types • The National Diabetes Data Group defines 4 major types of diabetes mellitus (DM) • Type 1 DM • Type 2 DM • Gestational Diabetes • Impaired Glucose Tolerance (Impaired fasting glucose)

  11. New versus Old Names • Type 1 DM (aka: juvenile onset, insulin dependent diabetes mellitus) • Type 2 DM (aka: adult onset, noninsulin dependent diabetes mellitus)

  12. pathophysiology • Type 1 Diabetes Mellitus • Abrupt failure of production of insulin • Parental insulin required to sustain life • Autoantibodies implicated in the cell-mediated autoimmune destruction of beta cells of the pancreas

  13. Diabetic ketoacidosis (DKA) - initial onset hyperglycemia Polyuria Polydipsia Polyphagia Ketosis Osmotic diuresis Eventual coma - hypovolemia Type 1 DM

  14. treatment • Type 1 Diabetes Mellitus • Insulin • SC injections • Pumps • Oral hypoglycemics • Insulin sensitizers with primary action in the liver • Metformin • Insulin sensitizers with primary action in peripheral tissues • Pioglitazone, rosiglitarzone • Insulin secretagogues • Repaglinide,, nateglinide • Carbohydrate absorption slowing agents • Acarbose, miglitol

  15. complications • Type 1 Diabetes Mellitus • Complications • Hypoglycemia • Hyperglycemia • Retinopathy, neuropathy, nephropathy, CAD, CVA, “silent MI”

  16. Pathophysiology Usually middle-aged or older, overweight Insulin deficiency (insulin secretory deficit) Impaired insulin function related to poor insulin production Failure of insulin to reach the site of action or, failure of end-organ response to insulin Type 2 DM

  17. Initial onset Hyperosmalar Hyperglycemic Nonketotic Coma (HHNC) Polyuria Polydipsia Polyphagia Osmotic diuresis Eventual coma - hypovolemia Type 2 DM

  18. Type 2 DM Treatment • Lower glucose levels on a consistent basis to normal or near normal • Lifestyle changes & metformin • Other oral antidiabetic agents • Insulin

  19. Gestational Diabetes • Glucose intolerance of variable degree with onset or 1st recognition during pregnancy

  20. Gestational Diabetes • Complications • Miscarriages • Birth defects • Growth acceleration & fetal obesity

  21. Hypoglycemia ALOC Lethargy Confusion Combativeness Agitation Seizures Focal neurologic deficits Unresponsiveness Hypglycemia Anxiety Nervousness Irritability N/V Palpitations Tremor Sweating Bradycardia Salivation s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives

  22. DKA • Diabetic ketoacidosis occurs primarily in patients with type 1 diabetes. • The incidence is roughly 2 episodes per 100 patient years of diabetes, with about 3% of patients with type 1 diabetes initially presenting with diabetic ketoacidosis. • It can occur in patients with type 2 diabetes as well; however, this is less common.

  23. DKA • The most common scenarios for DKA are • underlying or concomitant infection (40%) • missed insulin treatments (25%) • newly diagnosed, previously unknown diabetes (15%) • Other associated causes make up roughly 20% in the various series.

  24. HHNC • The incidence of hyperosmolar hyperglycemic state (HHS) is <1 case per 1000 person/year • making it significantly less common than DKA. As the prevalence of type 2 diabetes mellitus increases, the incidence of HHS will likely increase as well.

  25. Physical Exam Findings, Diagnostic Findings, S/S, pertinent positives

  26. Treatment • Hyperglycemia - DKA • Hyperosmalar Hyperglycemia Nonketotic Coma • Adults - All IVs macrodrip set (10-15 drops/ml) • Pediatrics All IVs measured-vol solution administration (Volutrol) • 0-6 yrs All IOs bolus with 60ml syringe, not Volutrol

  27. Treatment • Hyperglycemia - DKA • Hyperosmalar Hyperglycemia Nonketotic Coma • Saline Lock or TKO: may generally use interchangeably if fluid or medication not currently required but may be in future (exceptions are noted in specific PROTOCOLS). • Saline locks avoid IV line entanglement during complex extrications, however TKO allows for immediate administration of fluids as needed

  28. Treatment: DKA & HHNC • Maintenance fluids:stable pts with no contraindications to fluid (pulmonary edema): • Adults: 120ml/hr (macrodrip 1 drop q 2-3 sec) • Pediatrics: 2 ml/kg/hr or reference Broselow tape • Fluid challenge: • Adults (SBP80-100 or HR>100): 500ml bolus (recheck VS after bolus) • Pediatrics: bolus only - no challenge indicated

  29. DKA & HHNC: Treatment • Fluid bolus: • Adults (SBP<80): 1-L bolus wide open under pressure • Repeat SBP <80: repeat bolus once, then contact base • Pediatrics: shock, indicated by protocol: 20ml/kg/bolus • If improvement: repeat bolus once then contact base

  30. DKA & HHNC: Treatment • Pediatric Shock: SBP<(70+2x age in years) per PROTOCOL: PediatricParameters • In the case of fluid challenge or bolus: Contact base as soon as possible. If communication failure, continue per guidelines to a maximum of 3-L in adults and 60ml/kg in pediatrics

  31. DKA & HHNC: Treatment Fluid Challenge or Bolus Procedure • Check vitals & lung exam after each fluid challenge/bolus • As vitals change refer back to the table above for fluid guidelines (I.e., initial SPB=80, give 1-L bolus; recheck SBP=90, give 500ml bolus; recheck) • If signs of pulmonary edema (crackles, respiratory distress, increased respiratory rate) develop during IV fluid administration, decrease to TKO & contact base for fluid orders

  32. DKA & HHNC: Treatment • Notes • If PROTOCOL orders IV fluid, refer to this PROCEDURE for gauge, IV number, & fluid rate. If IV fluid orders differ from this it will be indicated in the specific protocol. • If it is likely that pt will not be transported, contact base prior to IV attempts

  33. Treatment • Hypoglycemia • See ALOC protocol- Adult & Peds • Hyperglycemia • Support ABCs • Airway mtg | vomiting/aspiration prevention • Large bore IV • Fluids

  34. Differential diagnosis • In the field: • Alcohol • Epilepsy • Insulin • Overdose • Uremia • Trauma • Infection • Psychosis • Stroke

  35. Perspective • Pathophysiology • Epidemiology • Physical Exam Findings • Diagnostic Findings • Signs and Symptoms • Differential considerations • Treatment

  36. Questions? • References • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.

More Related